Queer periods: attitudes toward and experiences with menstruation in the masculine of centre and transgender community.

Menstruation has long been viewed as an important aspect of women's health. However, scholars and healthcare providers have only recently begun to recognise that transgender men and people with masculine gender identities also menstruate, thus little is known about their attitudes toward and experiences with menstruation. A sample of masculine of centre and transgender individuals with a mean age of 30 years was recruited online to complete measures of attitudes toward menstruation and menstrual suppression and to answer exploratory questions about their experiences managing menstruation. Participants reported mixed attitudes toward menstruation, but generally positive attitudes toward menstrual suppression. Many participants said that they try to avoid public restrooms during menstruation because of practical and psychological concerns. Implications of our findings for the transgender health are discussed.

Reproduction in the endangered African wild dog: basic physiology, reproductive suppression and possible benefits of artificial insemination.

The African wild dog (Lycaon pictus) is an endangered exotic canid with less than 5500 animals remaining in the wild. Despite numerous strategies to conserve this species, numbers of free-living animals are in decline. It is a highly social species with a complex pack structure: separate male and female dominant hierarchies with, typically, participation of subdominant adults in the rearing of the dominant breeding pairs' pups. Basic reproductive knowledge is largely missing in this species, with only limited information available on the profile of reproductive hormones, based on non-invasive endocrine monitoring. The dominant or alpha male and female are reproductively active and the subdominants are generally reproductively suppressed. However, the occasional production of litters by subdominant females and evidence of multiple paternity within litters suggests that fertility of subordinates is not completely inhibited. In this respect, there are still considerable gaps in our knowledge about the mechanisms governing reproduction and reproductive suppression in African wild dogs, particularly the influence of dominance and pack structure on both male and female fertility. Given concerns over the long-term survival of this species, further research in this area is essential to provide valuable information for their captive breeding and conservation. Reproductive information can also be applied to the development of Assisted Reproductive Techniques for this species; the utility of which in African wild dog conservation is also discussed.

Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?

OBJECTIVE: To determine long-term outcomes after complete laparoscopic excision done at a tertiary referral center in a teenager population, who were not specifically advised to take postoperative hormonal suppression. DESIGN: Prospective observational case series (Canadian Task Force II-3). SETTING: A tertiary referral center that specializes in the laparoscopic treatment of endometriosis. PATIENT(S): Teenagers with symptoms suspicious for endometriosis who consented and were prospectively recruited to participate in the study. INTERVENTION(S): All patients underwent diagnostic laparoscopy and complete excision of all areas of abnormal peritoneum with typical and atypical endometriosis. Patients were not specifically advised to take postoperative hormonal suppression. MAIN OUTCOME MEASURE(S): Rate of recurrent (or persistent) endometriosis. RESULT(S): Twenty teenagers underwent complete laparoscopic excision of all areas of abnormal peritoneum with typical and atypical endometriosis. Seventeen patients had endometriosis confirmed by histology at initial surgery. Follow-up was up to 66 months (average 23.1 months). There was a statistically significant improvement in most pain symptoms, including bowel-related symptoms, during this time period. The rate of repeat surgery was 8 of 17 patients (47.1%), but the rate of endometriosis (diagnosed visually or histologically) found at surgery was zero. Only one-third of patients took postoperative hormonal suppression for any length of time. CONCLUSION(S): Complete laparoscopic excision of endometriosis in teenagers--including areas of typical and atypical endometriosis--has the potential to eradicate disease. These results do not depend on postoperative hormonal suppression. These data have important implications in the overall care of teenagers, regarding pain management, but also potentially for fertility. Further large comparative trials are needed to verify these results.

Ovarian hyperstimulation syndrome prevention strategies: oral contraceptive pills-dual gonadotropin-releasing hormone agonist suppression with step-down gonadotropin protocols.

The identification of patients at high risk for excessive responses to ovarian stimulation for in vitro fertilization and embryo transfer is essential in the tailoring of safe and effective treatment strategies. Known factors associated with increased sensitivity to gonadotropins include polycystic ovary syndrome, young age, prior ovarian hyperstimulation syndrome (OHSS), high baseline antral follicle count, and high baseline ovarian volume. Although several treatment strategies have been proposed for these patients, this report describes the experience using the dual suppression with gonadotropin step-down protocol. This protocol uses oral contraceptive pretreatment in combination with a long gonadotropin-releasing hormone agonist followed by a programmed step-down in gonadotropin dosing. Hormonal characteristics of dual suppression include an improved luteinizing hormone-to-follicle-stimulating hormone ratio and lower serum androgens, particularly dehydroepiandrosterone sulfate. Clinical characteristics of the protocol include a lower cancellation rate and favorable clinical and ongoing pregnancy rates per initiated cycle while mitigating the risk of OHSS.

Benefits and adverse effects of endocrine therapy.

Endocrine-responsive tumors that are small and without nodal involvement (i.e. tumors classified as pT1 pN0) are a heterogeneous group of tumors that are associated with a low risk of relapse in the majority of the cases. Therefore, the costs and benefits of adjuvant endocrine therapy should be carefully considered within this subgroup of patients. Treatment decisions should take into consideration co-morbidities as well as the presence of other classical risk factors such as HER2 overexpression or extensive peritumoral vascular invasion. Tamoxifen or tamoxifen plus ovarian function suppression should be considered as proper endocrine therapies in premenopausal patients. Ovarian function suppression alone or ovarian ablation might also be considered adequate in selected patients (e.g. very low-risk patients, in the presence of co-morbidities or patient preference). An aromatase inhibitor should form part of standard endocrine therapy for most postmenopausal women with receptor-positive breast cancer, although patients at low risk or with co-morbid musculoskeletal or cardiovascular risk factors may be considered suitable for tamoxifen alone. Tailored endocrine treatments should be considered in patients with endocrine-responsive tumors classified as pT1 pN0. Issues focusing on safety, quality of life and subjective side effects should be routinely discussed.

Endometriosis and assisted reproduction techniques.

Endometriosis-associated infertility is poorly treatable with various forms of surgery. Therefore, assisted reproduction techniques (ARTs), such as controlled ovarian hyperstimulation, intrauterine insemination, or in vitro fertilization, are commonly used for endometriosis-associated infertility. Endometriosis impairs the efficacy of in vitro fertilization. There is no evidence that ovulation suppression before ART would enhance the efficacy of ART. Resection of minimal/mild endometriosis and/or restoration of the normality of pelvic anatomy may enhance the efficacy of ART, but aggressive ovarian surgery should be avoided, because it reduces the ovarian reserves and the likelihood of pregnancy after ART. The outcome of ART pregnancy is not affected by the history of endometriosis, but the presence of endometrioma may predispose to preterm birth or fetal growth retardation in ART-induced pregnancies. As a whole, infertility due to endometriosis is best treated with various forms of ART, and the earlier clinicians apply these techniques, the more likely pregnancy may ensue.

Oligoovulatory and anovulatory cycles in women with polycystic ovary syndrome (PCOS): what's the difference?

CONTEXT: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder. The phenotype may differ between patients who exhibit signs of recent ovulation and anovulatory PCOS patients. OBJECTIVE: Our objective was to study differences in clinical and endocrine characteristics and response to ovulation induction (OI) treatment comparing oligoovulatory and anovulatory PCOS patients. DESIGN AND SETTING: We conducted a retrospective cohort study at a tertiary hospital. PATIENTS: PCOS patients (n=1750) presenting with oligo- or amenorrhea were diagnosed according to the Rotterdam 2003 consensus criteria. Arbitrarily, oligoovulatory PCOS was defined by a single random serum progesterone level of 10 nmol/liter or higher. MAIN OUTCOME MEASURES: We evaluated the incidence of oligo- or amenorrhea, menstrual cycle length, serum androgen levels, follicle count, and OI outcome parameters. RESULTS: Anovulatory women (n=1541 of 1750, 88.1%) were more often amenorrheic (P<0.001) and presented with a longer cycle duration (P<0.001) compared with oligoovulatory women (n=209 of 1750, 11.9%). Serum levels of testosterone (P<0.001), the free androgen index (P<0.001), and total follicle count (P<0.005) were higher in anovulatory compared with oligoovulatory patients. During clomiphene citrate OI, more oligoovulatory women gained regular menstrual cycles (P<0.05), whereas after second-line treatment with recombinant FSH, more anovulatory women became pregnant (P<0.05). CONCLUSIONS: Oligoovulatory women with PCOS exhibit a milder phenotype of ovarian dysfunction and have a more favorable response to OI treatment using clomiphene citrate compared with anovulatory PCOS patients. However, during second-line treatment with recombinant FSH, anovulatory PCOS patients presented with a higher chance of pregnancy compared with oligoovulatory patients.

The efficacy of recombinant equine follicle stimulating hormone (reFSH) to promote follicular growth in mares using a follicular suppression model.

The efficacy of a recently engineered single chain recombinant equine follicle stimulating hormone (reFSH) was investigated in estrous cycling mares whose gonadotropins and follicular activity had been suppressed by concurrent treatment with progesterone and estradiol (P&E). Time of estrus was synchronized in 15 estrous cycling mares during the breeding season with prostaglandins F(2alpha) (PGF(2alpha)). The day after ovulation, mares were treated once daily with P&E for 14 days. Mares received a second injection of PGF(2alpha) on day 6 of the synchronized estrous cycle to induce luteolysis. On day 8 post-ovulation mares were randomly assigned to three groups: small dose reFSH-treatment group (0.5mg reFSH IV, twice daily); large dose reFSH-treatment group (0.85mg reFSH IV twice daily); control group (saline IV, twice daily). reFSH treatment occurred concurrently with the last week of P&E treatment. After a follicle or cohort of follicles reached 35mm in diameter, mares were injected with 0.75mg of recombinant equine luteinizing hormone (reLH) to induce ovulation. Post-treatment ovulation was assessed. Daily blood samples were collected for analysis of FSH, LH, estradiol, progesterone, and inhibin by radioimmunoassay (RIA). On the first day of reFSH/saline treatment, blood samples were collected periodically from 1h prior to treatment to 6h post-injection via an indwelling jugular catheter to determine acute changes in FSH concentrations. Monitoring of follicular activity, estrus, and ovulation was performed daily by utilizing a stallion and transrectal ultrasonography. A difference (por=35mm follicles (days 16-21) than controls. Mares treated with reFSH, at either dose, took less time (average: 2.95+/-0.42 days) to develop 2-3 times more pre-ovulatory follicles than control mares (7.8+/-0.51 days) (p

Enhancement of inhibitory synaptic transmission in large aspiny neurons after transient cerebral ischemia.

Large aspiny neurons and most of the GABAergic interneurons survive transient cerebral ischemia while medium spiny neurons degenerate in 24 h. Expression of a long-term enhancement of excitatory transmission in medium spiny neurons but not in large aspiny neurons has been indicated to contribute to this selective vulnerability. Because neuronal excitability is determined by the counterbalance of excitation and inhibition, the present study examined inhibitory synaptic transmission in large aspiny neurons after ischemia in rats. Transient cerebral ischemia was induced for 22 min using the four-vessel occlusion method and whole-cell voltage-clamp recording was performed on striatal slices. The amplitudes of evoked inhibitory postsynaptic currents in large aspiny neurons were significantly increased at 3 and 24 h after ischemia, which was mediated by the increase of presynaptic release. Postsynaptic responses were depressed at 24 h after ischemia. Inhibitory postsynaptic currents could be evoked in large aspiny neurons at 24 h after ischemia, suggesting that they receive GABAergic inputs from the survived GABAergic interneurons. Muscimol, a GABA(A) receptor agonist, presynaptically facilitated inhibitory synaptic transmission at 24 h after ischemia. Such facilitation was dependent on the extracellular calcium and voltage-gated sodium channels. The present study demonstrates an enhancement of inhibitory synaptic transmission in large aspiny neurons after ischemia, which might reduce excitotoxicity and contribute, at least in part, to the survival of large aspiny neurons. Our data also suggest that large aspiny neurons might receive inhibitory inputs from GABAergic interneurons.

Post-conception reproductive competition in cooperatively breeding common marmosets.

Common marmosets are cooperatively breeding monkeys that exhibit high female reproductive skew. Subordinate females usually fail to breed as a consequence of ovulation suppression and inhibition of sexual behavior, and, even when they do breed, typically rear fewer infants than dominants. We evaluated possible mechanisms of post-conception reproductive competition by comparing hormonal profiles across pregnancy, pregnancy outcomes, infant survivorship, and behavior in laboratory-housed families containing one (N=9) or two (N=7) breeding females. Breeding females in plurally breeding groups did not exhibit well-defined dominance relationships and rarely engaged in escalated aggression with one another. No significant differences were found among singly breeding mothers, plurally breeding mothers, and plurally breeding daughters in urinary chorionic gonadotropin or estradiol sulfate concentrations during pregnancy, fetal biparietal diameter, frequency of spontaneous abortion, frequency of stillbirths, number of live-born infants per litter, or infant mortality rates. When females gave birth while another female in the family was pregnant, however, their infants were highly likely to be killed. The perpetrator was definitively identified in only one family, in which a pregnant female killed her daughter's infant. These results are consistent with observations of free-living common marmosets and suggest that breeding females do not regularly influence one another's pregnancy outcomes, but that they may commonly kill each other's infants, especially during their own pregnancy. Our findings further suggest that infanticide by breeding females may have selected for the evolution of reproductive restraint in subordinate female marmosets.

Effect of octapeptide: FSH binding inhibitor on cyclicity of bonnet monkeys (Macaca radiata).

BACKGROUND: The gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone play an important role in the development of ovarian follicles, and a number of autocrine/paracrine factors secreted by the ovary are known to directly or indirectly regulate gonadotropin action. The objective of the present study was to elucidate the effect of octapeptide (OP) on cyclicity and hormonal profile of bonnet monkeys, the menstruating Old World primates. STUDY DESIGN: Our group has purified one such factor from human ovarian follicular fluid, which inhibits the binding of FSH to the granulosa cells. N-terminal eight-amino-acid sequence of this peptide has been deduced, which is referred to as the OP. It has shown an antifertility effect in marmosets, the New World primates. In the present study, the bonnet monkeys were divided into two groups, namely, the treated group (n=5), which was administered with OP (250 mcg/kg body weight/day) intramuscularly during the follicular phase, and the control group (n=6), which was injected with vehicle (saline). Blood was collected every other day, and progesterone levels were estimated by enzyme-linked immunosorbent assay. RESULTS: Animals in the control group demonstrated normal plasma progesterone levels and exhibited normal cyclicity. On the other hand, in the treated group, progesterone levels decreased by 65.8%, as compared with that in pretreatment cycles. This probably disturbed the cyclicity, thus causing amenorrhea (73.0+/-6.7 days).

Relevance of ovarian signaling for the early behavioral transition from estrus to pregnancy in the female rabbit.

During estrus, the female domestic rabbit (Oryctolagus cuniculus) displays scent marking behavior (chinning), which is immediately inhibited after mating, temporarily recovers, and then declines and remains inhibited across pregnancy. Chinning is inhibited by progesterone (P) and the activation of the progesterone receptor (PR), but it is unlikely that P participates in the "acute" (immediate) or "early" inhibition of chinning (24 to 96 h post-mating, before plasma P levels rise). Since PR is activated in a ligand-independent manner by a variety of signaling molecules, some of which (e.g., GnRH) are also associated with reflexive ovulation in this species, we hypothesized that neurochemical/neuroendocrine signals associated with mating activate PR, resulting in the inhibition of chinning. In Experiment 1, we tested whether the PR antagonist, RU486 (20 mg, injected s.c. at -1 h, or at -7 h and +3 h relative to mating) prevented the post-mating inhibition of chinning in intact females. RU486 did not prevent the post-mating decline in chinning, indicating that PR activation associated with mating is not necessary for this effect. In Experiment 2, we used ovariectomized (OVX), estradiol benzoate (EB)-treated females to test the hypothesis that ovarian signaling is necessary for the post-mating inhibition of chinning. The acute inhibition of chinning occurred in OVX females, but the early inhibition was absent. We conclude that ovarian signaling is necessary for the early, but not acute, post-mating inhibition of chinning. The PR seems not to participate in either of these phases.

Inhibition of metastin (kisspeptin-54)-GPR54 signaling in the arcuate nucleus-median eminence region during lactation in rats.

Follicular development and ovulation are suppressed during lactation in various mammalian species, mainly due to the suppression of pulsatile GnRH/LH secretion. Metastin (kisspeptin-54), a KiSS-1 gene product, is an endogenous ligand for GPR54, a G-protein-coupled receptor, and suggested to play a critical role in regulating the gonadal axis. The present study therefore aims to determine whether metastin (kisspeptin-54)-GPR54 signaling in discrete brain areas is inhibited by the suckling stimulus that causes suppression of LH secretion in lactating rats. Quantitative RT-PCR revealed that the KiSS-1 mRNA level was significantly lower in the arcuate nucleus (ARC)-median eminence region in lactating ovariectomized (OVX) and estrogen-treated OVX rats than in nonlactating controls. KiSS-1 mRNA in the anteroventral periventricular nucleus was kept at a low level in both lactating and nonlactating rats despite estrogen treatment. GPR54 mRNA levels were significantly lower in lactating than nonlactating rats in the anteroventral periventricular nucleus, but the levels in lactating mothers of the preoptic area and ARC-median eminence were comparable with nonlactating controls. Although KiSS-1 mRNA-expressing cells or metastin (kisspeptin-54) immunoreactivities were densely located in the ARC of nonlactating controls, few were found in the ARC of lactating OVX animals. Various doses of metastin (kisspeptin-54) (0.02, 0.2, and 2 nmol) injected into the third ventricle caused a significant increase in LH secretion in both lactating and nonlactating OVX rats, suggesting that lactating rats are responsive to metastin (kisspeptin-54) stimulus. Thus, the present study demonstrated that KiSS-1 mRNA/metastin (kisspeptin-54) expression is inhibited in the ARC by the suckling stimulus, suggesting that the inhibition is most probably involved in suppressing LH secretion in lactating rats.

Do dispersing non-reproductive female Damaraland mole-rats, Cryptomys damarensis (Rodentia: Bathyergidae) exhibit spontaneous or induced ovulation?

The Damaraland mole-rat is a eusocial, subterranean rodent that exhibits a seasonal breeding. Non-reproductive females show physiological suppression of reproduction whilst in the confines of the natal colony. This study set out to investigate whether dispersing female Damaraland mole-rats exhibit induced or spontaneous ovulation. Fifteen non-reproductive females were removed from their natal colonies and housed individually for a period of 6 weeks. During this period urine was collected from all animals every second day. After this initial period the animals were divided into 3 groups. Females were subjected to 1 of 3 trials: a control group housed separately without a male, allowed non-physical contact, or placed in direct physical contact with vasectomized males. Urine was collected for a further 5 weeks, and urinary progesterone profiles established. All three groups showed a significant difference in urinary progesterone concentrations between the two treatment periods indicating initiation of follicular development in all animals following removal from the colony. Histological results further revealed that at least one animal in the control group and five of the six animals in the vasectomized group had corpora lutea present in the ovaries showing that ovulation has taken place. All groups had similar numbers of Graafian follicles, indicating that all females were likely to ovulate in the near future. This finding suggests that females are capable of spontaneous ovulation, but the act of coitus may advance the onset of ovulation in this arid dwelling mole-rat.

Lifetime egg maturation by host-deprived Venturia canescens.

The study investigated egg maturation and deposition by the endoparasitoid wasp Venturia canescens under conditions of host deprivation. Female V. canescens maintained without hosts began to deposit eggs onto the sides of the culture vessel on the day of eclosion. The maturation of additional eggs was not inhibited once the maximum oviduct egg load was reached but rather continued for the duration of the experiment (up to 39 days), at a rate of around 5.8% of the remaining unmatured eggs per day. Following host access, wasps matured additional eggs at an increased rate. Artificial damage to the ovipositor resulted in a reduced rate of egg maturation even though the oviducts were partly egg depleted, while damage to the auxiliary valvulae had no effect. These results suggest two conclusions. Under conditions of host deprivation, the rate at which eggs are matured is determined by the rate of synthesis of precursors by the fat body that in turn is modified by feedback from the ovipositor, induced by physical stimulation. Further, the discarding of eggs is due to the involuntary unidirectional movement of eggs down the oviduct, facilitated by the ongoing maturation of additional eggs.

Seasonal adiposity and delayed ovulation in a vespertilionid bat, Scotophilus heathi: role of tumor necrosis factor-alpha.

The aim of this article was to evaluate the physiological significance of tumor necrosis factor-alpha (TNF-alpha) in seasonal accumulation of adipose tissue, hyperinsulinemia, and anovulation in Scotophilus heathi. The result showed seasonal variations in the circulating TNF-alpha level. A higher level of circulating TNF-alpha was observed during quiescence and recrudescence, whereas a lower level of TNF-alpha was observed during winter dormancy and the preovulatory period. An increased circulating TNF-alpha level coincided closely with accumulation of adipose tissue and hyperinsulinemia. Immunocytochemical localization of TNF-alpha in the ovary showed immunoreactivity mainly in the oocytes and theca-interstitial cells. The oocytes of small and medium-sized follicles showed strong TNF-alpha immunostaining, whereas weak immunoreactivity was observed in the large antral follicles. The atretic follicles showed mild TNF-alpha immunostaining. TNF-alpha immunoreactivity in the ovary was slightly higher during the quiescence and preovulatory periods compared with the periods of recrudescence and winter dormancy. TNF-alpha alone significantly increased androstenedione and estradiol production by the ovary in vitro but did not augment the luteinizing hormone (LH)-induced androstenedione production. However, TNF-alpha did augment LH-induced estradiol production. The results of this study suggest the involvement of TNF-alpha in the interaction among adipose tissue accumulation, insulin resistance, and ovarian activity in S. heathi.

Evidence that failure to conceive despite apparent correction of ovulatory defects by follicle-maturing drugs may be related to premature trophoblast invasion.

There is evidence that follicle-maturing drugs, especially when used for controlled ovarian hyperstimulation for in vitro fertilization-embryo transfer (IVF-ET) purposes, may be associated with lower pregnancy rates following ET related to a hostile uterine environment. It was assumed that this was related to implantation failure of the embryos. However, there is a possibility that the embryo may implant too soon into a uterine environment not ready for the invading trophoblast. To test this hypothesis a 34kDa protein known as the progesterone-induced blocking factor (PIBF), which only rises after trophoblast invasion, was measured at the peri-implantation time 3 days after ET. The results showed a marked reduction in pregnancy rates per transfer in those positive for PIBF at this time especially in those receiving controlled ovarian hyperstimulation. Thus, these data suggested that premature trophoblast invasion rather than failure for embryos to implant may be the etiologic factor responsible for the adverse effect of controlled ovarian stimulation in the uterine environment.

Efficacy and effectiveness of LAM.

Two major protocols of non-randomized clinical trials of the efficacy of the Lactational Amenorrhea Method of contraception (LAM) were performed in the 1990s that suggested LAM to be a highly effective albeit temporary method of contraception. Data from a longitudinal study of over 4000 breastfeeding women performed by the World Health Organization provide supporting information as to the efficacy of LAM. Effectiveness data are scarce, as is information on the use of LAM in industrialized countries. Issues surrounding LAM efficacy and effectiveness are reviewed, and the existing information from industrialized countries is highlighted.